Reactor used in trial of new cancer therapy

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he first clinical trial of a novel form of experimental cancer therapy in which MIT plays a major role got under way last week at the Research Reactor. The event culminated efforts that began six years ago.

The treatment was the first use of boron neutron capture therapy on a human patient in the United States in more than 30 years and the first ever use of an epithermal beam (intermediate energy) for neutron-capture therapy.

MIT, the New England Medical Center and Boston University Medical Center are involved.

Leading the work are Professor Otto M. Harling, Department of Nuclear Engineering and director of the MIT Nuclear Reactor Laboratory; Dr. Robert Zamenhof, senior medical physicist at the New England Medical Center; and Dr. Hywel Madoc-Jones, radiotherapist in chief and head of the Department of Radiation Oncology at New England Medical Center. Dr. Gary Rogers, a Boston University Medical Center dermatologist, is also participating in the clinical aspects.

Professor Harling stressed that the achievement was the result of "a major interdisciplinary and interinstitutional effort on several fronts." A number of faculty and staff from the Department of Nuclear Engineering and the Reactor Laboratory have been involved over the last six years with colleagues at the other institutions.

The therapy's target is glioblastoma, a highly malignant brain cancer that kills about 8,000 people in the United States each year.

The clinical trial that began September 6 was required by the Food and Drug Administration to demonstrate that the therapy will not cause harm. Consequently, the trial calls for treating a limited number of patients who have melanomas on their arms or legs. The treatment starts with a low dose of radiation and is stepped up over several days to a therapeutic level. The Nuclear Regulatory Commission, the Department of Energy, and nine MIT and New England Medical Center committees also have approved the trial.

The therapy involves the patient consuming a drink containing boron. The boron is taken up largely by the tumor cells. The tumor is then irradiated with a neutron beam. The neutrons cause the boron to split into two highly energetic particles which destroy the tumor cells while largely sparing adjacent healthy cells. Why the boron is attracted to the tumor cells and how these cells are then destroyed by the treatment is not known.

The clinical trials take place in a "med room" below the core of the reactor. The patient reclines on a table that can be precisely positioned so that the tumor site aligns with the reactor beam. The initial volunteer is a man in his early 60s who has a melanoma on the sole of his foot.

The therapy was first attempted in the United States in the 1950s at Brookhaven National Laboratory in Upton, NY, and in the 1960s at MIT. Those trials were unsuccessful. The present effort using the MIT reactor benefits from an improved boron-containing drug, improved neutron beams, accurate and rapid boron analysis technology and other important advances, the researchers said. For example, in the 1950s and 1960s, thermal (low energy) neutron beams were used. These required that the skull be opened surgically to allow the neutron beam to reach the tumor site. The current MIT beam is an epithermal one that can penetrate more deeply. No surgery is therefore needed.

The Department of Energy's Office of Energy Research and the Herbert M. Karol Cancer Foundation in Brookline are funding the work. New England Medical Center and MIT also contributed.

Individuals interested in the clinical trials are asked to have their primary care physicians contact New England Medical Center (617-956-6167) or Boston University Medical Center (617-638-8491).

A version of this article appeared in MIT Tech Talk on September 14, 1994.